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NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO 1998 – Received second honorary doctorate from Grand Betty Vallet S...

NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO 1998 – Received second honorary doctorate from Grand Betty Vallet State University, Neuman Allendale, Michigan 1924 - 2022 Neuman’s System Model Major Concepts and Definition → Began working as a nurse after The aim of the Neuman earning her Master’s degree model “is to set forth a → was a pioneer in nursing structure that depicts the involvement in community parts and subparts and their mental health interrelationships for the → was named as an Honorary whole of the client as a Member of the Fellowship of the complete system” American Academy of Nursing Has two major components: → published the “The Neuman Systems Model” in 1982 Neuman’s System Model → spent her time educating nurses and professors about her model through her work as an author and speaker reactions to stress stress History and Background 1924 – born near Lowell, Ohio is viewed as an open system 1947 – Received RN diploma in which repeated cycles of from People’s Hospital School of input, process, output, and Nursing in Akron, Ohio feedback, constitute a 1957 – attended University of dynamic organizational California at Los Angeles (UCLA) pattern. with double major in The client may be an psychology and public health individual, a group a family, a 1966 – received Master’s degree community, or an aggregate. in Mental Health, Public Health Major concepts identified in Consultation from UCLA the model are: 1972 – “Model for Teaching Total → wholistic approach Person Approach to Patient → open system Problems” was published → environment 1985 – Received doctorate in → client system Clinical Psychology from Pacific → normal line of defense Western University → flexible line of defense  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO → health stress and reaction to stress → stressors are basic components of an → degree of reaction open system → prevention as Functions of Process intervention → reconstitution exchanges “energy, information, and matter with Wholistic approach the environment as well as is a dynamic, open, systems other parts and subparts of approach to client care the system” as it uses originally developed to available energy resources provide a unifying focus for to move stability and defining nursing problems wholeness and for understanding the Input and Output client in interaction with the environment. “matter, energy, and the client as a system may be information that are defined as a person, family, exchanged between the group, community, or social client and the environment” issue clients are viewed as wholes Feedback whose parts in dynamic interaction system output in the form of considers all variables “matter, energy, and simultaneously affecting the information serves as client system: physiological, feedback for future for psychological, sociocultural, corrective action to change, developmental, and spiritual enhance, or stabilize the Neuman changed the system” spelling of the term holistic Negentropy to wholistic. Wholistic refers to the whole “a process of energy person. conservation that increases organization and complexity, Open System moving the system toward a system is open when stability at a higher degree of “there is a continuous flow wellness” of input and process, output, Stability and feedback.” is a dynamic and “desirable state of balance in which  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO energy exchanges can take Developmental variable – place without disruption of refers to age related the character of the system,” processes and activities which points toward optimal Spiritual variable – refers to health spiritual beliefs and influences Environment Basic Structure “the environment consists of both internal and external composed of a central core forces surrounding the client, surrounded by concentric influencing, and being rings influenced by the client, at the inner circle of the any point in time” diagram represents the basic survival factors or energy Created Environment resources of the client developed unconsciously by “consists of basic survival the client to express system factors common to human wholeness symbolically. beings,” such as innate or “its purpose is to provide genetic features perceptual protection for Lines of Resistance client system functioning and to maintain system stability” a series of broken rings surrounding the basic core Client System structure “a composite of five these rings represent variables (physiological, resource factors that help psychological, sociocultural, the client defend against a developmental, and stressor spiritual) in interaction with “serve as protection factors the environment” that are activated by Physiological variable – stressors penetrating the refers to body structure and normal line of defense” function Normal Line of Defense Psychological variable – refers to mental process in the model’s outer solid circle interaction with the represents the “adaptation environment level of health developed Sociocultural variable – over the course of time and refers to the effects and serves as the standard by influences of social and which to measure wellness cultural conditions deviation determination”  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO expansion of the normal line Stressors of defense reflects an are tension producing stimuli enhanced wellness state, “that have the potential to and contraction indicates a disrupt system stability, diminished wellness state leading to an outcome that Flexible Line of Defense may be positive or negative may arise from the the model’s outer broken following: ring 1. Intrapersonal forces occurring perceived as a protective within the individual. buffer for preventing 2. Interpersonal forces occurring stressors from breaking between one or more through the usual wellness individuals such as role state as represented by the expectations. normal line of defense 3. Extrapersonal forces occurring situational factors can affect outside the individual such as the degree of protection financial circumstances afforded by the flexible line of defense both positively Degree of Reactions and negatively represents system instability Health that occurs when strategies invade the normal line of a continuum of wellness to defense illness that is dynamic in nature Prevention as Intervention “optimal wellness exists are purposeful actions to when the total system needs help the client retain, attain, are being completely met” or maintain system stability Wellness can occur they can occur before after “exists when all system protective lines and defense subparts interact in harmony and resistance are with the hole system and all penetrated system need are being met” Neuman’s three levels of Illness intervention: “exists at the opposite end of a) primary the continuum from wellness b) secondary and represents a state of c) tertiary instability and energy depletion” Primary Intervention  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO → used when one stressor is It represents return of the suspected or identified system to stability, which → a reaction has not yet may be the higher or lower occurred, but the degree of level of wellness than before risk is known stressor invasion. → the purpose is to reduce the possibility of encounter with I. Person Variables a stressor or to decrease the → Physiological Variable possibility of reaction. Ex. Individual System, Secondary Intervention Community System → involves interventions or → Psychological Variable treatment initiated after Ex. Self-esteem and its effect of symptoms from stress have relationships for the individual occurred. and communication patterns for → the client’s internal and a family external resources were used to strengthen internal → Developmental Variable lines of resistance, reduce Ex. Empty Nest Syndrome reaction and increase resistance factors. Sandwich Generation Tertiary Intervention → Sociocultural Variable → occurs after the active Ex. Ethnic cultural practices and treatment for secondary health belief practices on prevention stage birthing, food preferences in → it focuses on any adjustment different regions of the country, toward optimal client system and care of the dying and dead stability. → Spiritual Variable → the goal is to maintain optimal wellness Ex. Anointing the sick or dying representing recurrence of with oil, among Roman reaction or regression. Catholics, avoiding scavenger → Tertiary prevention needs fishes (shrimp, squids, crabs, back in a circular fashion fishes with no scales) among towards primary Seventh Day Adventists, reformation. prohibiting blood transfusion among Jehovah’s Witnesses Reconstruction II. Central Core occurs after treatment for → made up of basic “survival stressor reactions. factors”  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO → include system variables, evade the normal line of genetic features, and the defense. strengths and weaknesses of Ex. activation of the immune the system parts response after invasion of Ex. hair color, body microorganisms. temperature regulation VI. Reconstitution ability, functioning of body → The increase in energy that systems homeostatically, occurs in relation to the cognitive ability, physical degree of reaction to the strength, and value systems. stressor III. Flexible Line of Defense → Begins at any point following → outer barrier or cushion to initiation of treatment for the normal line of defense, invasion of stressor. line of resistance, and the VII. Stressors core structure → The Newman’s system, → described as accordion-like although focuses on the as it expands away from or impact of stressors and contracts closer to the health, and addresses stress normal line of defense and reduction of stress. → dynamic and can be changed → A stressor is any or altered in relatively short environmental force which period of time can potentially affect the IV. Normal Line of Defense stability of the system. → represent stability over time Intrapersonal forces occur within → considered to be the usual the individual. (emotion and level of stability in the feelings, hypertension, low blood system glucose) → can change over time in response to coping or Interpersonal forces occur between responding to the individuals. (role expectations, environment perceptions of caregiver, friend relationships) Ex. Skin which is stable and fairly constant but can Extrapersonal forces occur outside thicken into a callus over the individual (job or finance time pressure) V. Lines of Resistance VIII. Prevention → Protect the basic structure → the primary nursing intervention and become activated when environmental stressors  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO → focuses on keeping stresses and Metaparadigm of Neuman distress response from having a Human Beings (Person/Client) detrimental effect on the body presents the concept of Primary Prevention human beings as an open occurs before the system client system in reciprocal reacts to a stressor interaction with the strengthens the person to environment. enable him to better deal the client may be an with stressors, and on the individual family group other hand manipulates the community or social issue. environment to reduce or The person is a layered weaken stressors multidimensional being prevention includes health consists of physical or promotion and maintenance psychological, psychological, of wellness social, cultural, developmental, spiritual. Secondary Prevention “an unlimited entity with an occurs after the system active personality system reacts to a stressor in this whose evolution follows provided in terms of existing principles, symbolism, and systems systematic organizations...it focuses on preventing is not always possible to see damage to the central core the potential expansions of by strengthening the this entity” internal lines of resistance Health and or removing the stressor. sees health as being equated with wellness Tertiary Prevention she defines health as “the occurs after the system has condition in which all parts been treated through and subparts (variables) are secondary prevention in harmony with the whole strategies of the client” offers support to the client the state of wellness is in and attempts to add energy dynamic equilibrium, rather to the system or reduce than in any kind of steady energy needed in order to state facilitate reconstitutions. the client system moves towards illness and death  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO when more energy is needed system, through nursing than is available interventions to reduce the client system moves stressors. towards wellness when Neuman states that because more energy is available the nurse's perception will than needed influence the care given, then not only must the Environment patient/client's perceptions Neuman defines be assessed, but so must "environment as all the those of the caregiver internal and external factors (nurse). that surround and influence Neuman’s Six Steps of Nursing the client system." Process Stressors (intrapersonal, interpersonal, and First is the assessment of the extrapersonal) are patient, which looks at: actual and significant to the concept of potential stressors, condition and environment and are strength of basic factors and energy described as environmental sources; characteristics of flexible forces that interact with and and normal lines of defense, lines of potentially alter system resistance, degree of reaction and stability. potential for reconstitution. Nursing Second, the nurse makes a diagnosis by interpreting the data Neuman sees nursing as a collected. The data includes health- "unique profession that is seeking behaviors, activity concerned with all of the intolerance, ineffective coping, and variables which influence the ineffective thermoregulation. response a person might have to stressor." The third step in the nursing The person is seen as a process is to set goals. The ultimate whole, and it is the task of goal is to keep the client system nursing to address the whole stable. From the goals, a plan is person. created, which focuses on Neuman defines nursing as strengthening lines of defense and actions which assist resistance. That plan is individuals, families and implemented using primary, groups to maintain a secondary, and tertiary preventions. maximum level of wellness, Finally, the nursing process is and the primary aim is evaluated to determine whether or stability of the patient/client not balance was restored, and a stable state maintained. NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO explicates her definitions of the behavioral system Dorothy model. Johnson 1919 - 1999 Theoretical Sources “The client is a living open system, a collection of behavioral subsystems Johnson's Behavior System that interrelate to form a behavioral Model was greatly system" influenced by Florence History and Background Nightingale's book, "Notes in Nursing" (Johnson 1992). born August 21 1919, in Savannah Georgia. Major Concepts and From 1949 until her Definitions retirement in 1978, she was Behavior an assistant professor of expressed by behavioral and pediatric nursing, an biological scientists that is, associate professor of the output of intra nursing, and a professor of organismic structures and nursing at the University of processes as they are California in Los Angeles. coordinated and articulated had an influence on nursing by and responsive to through her publications changes in sensory since the 1950s. Johnson has stimulation. stressed the importance of research-based knowledge System about the effect of nursing "A system is a whole that care on clients. functions as a whole by virtue Johnson's Behavior System Model of the interdependence of its parts" In 1968 Dorothy Johnson first proposed her model of Behavioral System nursing care as fostering A behavioral system "the efficient and effective encompasses the patterned, behavioral functioning in the repetitive, and purposeful patient to prevent illness." ways of behaving. In 1980, Johnson published Usually the behavior can be her conceptualization of described and explained. "Behavioral System Model for Nursing"; this is the first A person as behavioral work of Johnson that system tries to achieve  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO stability and balance by socially acceptable behaviors for adjustments and adaptations excretion of waste but the that are successful to some existence of such a pattern remains degree for efficient and different from culture to culture. effective functioning. 5. Sexual subsystem: "both The system is usually flexible biological and social factors affect enough to accommodate the the behavior in the sexual influences affecting it subsystem." E.g., role identity, Subsystems courting, mating. The function is procreation and gratification. The behavioral system has many tasks to perform, therefore parts of 6. Aggressive-Protective the system evolve into subsystems subsystem: "related to the behavior with specialized tasks. concerned with protection and self- preservation; one that generates A subsystem is "a mini system with defensive response from the its own particular goal and function individual when life or territory is that can be maintained as long as its being threatened. relationship to other subsystems or the environment is not disturbed". 7. Achievement subsystem: "provokes behavior that attempts Johnson proposed that the client is to control the environment; a behavioral system, organized into intellectual, physical, creative, seven subsystems of behavior mechanical and social skills which are as follows: Each subsystem has three 1. Attachment affiliative subsystem: functional requirements: "social inclusion, intimacy, and the formation and attachment of a 1. must be protected from strong social bond. noxious influences with which system cannot cope 2. Dependency subsystem: 2. must be nurtured through "approval, attention or recognition, the input of appropriate and physical assistance (helping or supplies from the nurturing). environment 3. Ingestive subsystem: "the 3. must be stimulated for use emphasis is on the meaning and to enhance growth and structures of the social events prevent stagnation surrounding the occasion when the Equilibrium food is eaten, its function is appetite satisfaction. Johnson (1961b) stated that equilibrium is a key concept 4. Eliminative subsystem: human in nursing's specific goal. cultures have defined different  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO It is defined as "a stabilized result in a degree of but more or less transitory, instability are called resting state in which the stressors. individual is in harmony with "Stimuli may be positive in himself and with his that they are present; or environment" negative in that something desired or required is absent. Regulation/Control Use of Empirical Evidence: The interrelated behavioral subsystems must be The empirical origins of this regulated in some fashion so theory begins with that its goals can be realized. Johnson's use of systems Regulation implies that thinking (synthesis). deviations will be detected This process concentrates on and corrected. Feedback is, the function and behavior of therefore, a requirement of the whole and is focused on effective control. understanding and explanation of the Tension behavioral system. "The concept of tension is Major assumptions defined as a state of being stretched or strained and There are 4 assumptions of the can be viewed as an end- Behavioral System model: product of a disturbance in 1. There is organization, interaction, equilibrium" interdependency, and integration of Tension can be constructive the parts and elements of behaviors in adaptive change or that make up the system". destructive in inefficient use of energy, hindering 2. A system tends to achieve a adaptation and causing balance among the various forces potential structural damage operating within and upon it, and that man continually strives to Stressor maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces upon him. 3. A behavioral system, which both requires and results in some degree Internal or external stimuli of regularity and constancy in that produce tension and behavior is essential to man that is  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO to say, it is functionally significant in 1. insufficiency that it serves a useful purpose, both 2. discrepancy in social life and for the individual. 3. incompatibility 4. dominance 4. The final assumption states "system balance reflects Attachment-Affiliative Subsystem adjustments and adaptations that Function: are successful in some ways and to some degree." To form cooperative and interdependent role Goal Set Choice of Behavior relationships within human Behavior (Action) social systems To enjoy interpersonal The Goal of a subsystem is relationships defined as "the ultimate To belong to something consequences of behaviors" other than oneself. (Grubbs) To share. The basis for the goal is a To achieve intimacy and universal drive, the existence inclusion. of which is supported by existing theory or research. Metaparadigm of Johnson Set is a tendency to act in a certain Person way in a given situation. Set formation is influenced by societal A "human being" having two norms and variables as culture, major systems, the biological family, values, perception, and system and the behavioral perseveratory sets. system. Choice refers to the alternate Health behaviors the person considers in Johnson perceived health as any given situation. Options are an elusive, dynamic state influence by such variables as age, influenced by biological, sex, culture, and socioeconomic psychological, and social status. factors The action is the observable Nursing behavior of the person. has a primary goal that is to The Johnson's behavioral System foster equilibrium within the model differentiates four individual. diagnostic classifications to An external regulatory force delineate these disturbances: that is indicated only when there is instability.  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO There are four goals of nursing An assessment based on which are as follows: behavioral model does not easily permit the nurse to whose behavior is gather detailed information commensurate with social about the biological systems: demands ✓ Affiliation who is able to modify his ✓ Dependency behavior in ways that ✓ Sexuality supports biological ✓ Aggression imperatives ✓ Elimination who is able to benefit to the ✓ Ingestion fullest extent during illness ✓ Achievement from the physician's ✓ Restorative knowledge and skill whose behavior does not Diagnosis give evidence of Diagnosis tends to be unnecessary trauma as a general to the system that is consequence of illness specific to the problem. Environment Grubb has proposed 4 categories of nursing Consists of all the factors diagnoses derived from that are not part of the Johnson's behavioral system individual’s behavioral model: system, but that influenced the system 1. Insufficiency - a state which exists It’s also the source of when a particular subsystem is not sustainable imperatives of functioning or developed to its protection, nurturance and fullest capacity due to inadequacy stimulation that are of functional requirements. necessary prerequisites to 2. Discrepancy - behavior that does maintain health. not meet the intended goal. The Nursing Process and Johnson’s incongruity usually lies between the Behavioral System Model action and the goal of the subsystem, although the set and Assessment choice may be strongly influencing Grubbs developed an the ineffective action. assessment tool based on 3. Incompatibility - the goals or Johnson's seven subsystems behaviors of the two subsystems in plus a subsystem she labeled the same situation conflict with as restorative which focused each other to the detriment of the on activities of daily living. individual.  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO 4. Dominance - the behavior in one nurse centered activity with subsystem is used more than any the nurse determining the other subsystem regardless of the client’s needs and state situation or to the detriment of the behavior appropriate for the other subsystems. need. Outcomes, Planning and Implementation Implementation of the nursing care related to the diagnosis may be difficult because of lack of client’s inputs in the plant. The plan will focus on resist actions to modify client’s behavior. These plans then have a goal to bring about homeostasis in a subsystem based on nursing assessment of the individual’s drive, set behavior, repertoire and observable behavior. The plan may include protection, nurturance or stimulation of the identified subsystem. Evaluation Evaluation is based on the attainment of a goal of balance in the identified subsystems. If the baseline data are available for an individual, the nurse may have a goal for the individual to return to the baseline behavior. Johnson’s behavioral model with the nursing process is a NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Johnson’s Behavioral System Model  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Works of Imogene King Some of her works include: Imogene King "A theory for Nursing: Systems, Concepts, Process" 1923 - 2007 (1981) "The Language of Nursing Theory and Meta- theory" History and Background "Toward a Theory of born January 30, 1923 in Nursing: General Concepts of West Point, Iowa Human Behavior" (1971) Received her diploma in "Curriculum and Instruction nursing from St. John’s in Nursing: Concepts and Hospital School of Nursing in Process" (1986) St. Louis Missouri, in 1945 Major Concepts and Definition and her Bachelor and Master of Science, Degree in Concepts give meaning to our sense Nursing from St. Louis perceptions and permit University in 1948 and 1957, generalizations about person. respectively objects, and things She received an honorary Self Doctor of Philosophy degree from Southern Illinois "The self is a composite of University. thoughts and feelings which In 1996 Dr King received constitute a person's American Nurses Association awareness of his individual (ANA) Jenny M. Scott Award existence, his conception of for her contributions to who and what he is. demonstrating the A person's self is the sum interrelationships among total of all he can call his. The nursing practice education self includes, among other and research. things, a system of ideas, She was a participant at the attitudes, values, and First National Conference on commitments. the Classification of Nursing It is a distinctive center of Diagnosis in St. Louis in 1973. experience and significance. The self- constitutes a person's inner world as distinguished from the outer world consisting of all other people and things.  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO The self is the individual as Examples: religious, known to the individual. It is educational, healthcare that to which we refer when systems we say, "I" King’s Middle-Range Theory of Goal Developing the Conceptual System Attainment The human process of interactions formed the basis for designing a model of transactions that depicted theoretical knowledge used by nurses to help individuals and groups attain goals 1981 – King derived her middle- range Theory of Goal Attainment from her conceptual system. The question that motivated King to develop this theory was “What is King demonstrated that the nature of nursing?” conceptual system provides “one approach to studying She noted that the answer is “the systems as a whole rather way in which nurses, in their role, do than as isolated parts of a with and for individuals that system” differentiates nursing from other King believed that her health professionals” framework “differs from Theory development processes: other conceptual schema in that it is concerned not with What are the philosophical fragmenting human beings assumptions? and the environment but Are the concepts clearly with human transactions in identified and defined? different kinds of Are the concepts related in environments” propositional statements or models? Social System Does the theory generate more comprehensive questions to be answered or interacting system consists hypotheses to be tested in of groups that make up research to generate society knowledge and affirm the theory?  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Nonparticipant observation – optimum use of one's King’s method to collect resources to achieve information about nurse-patient maximum potential for daily interactions living Criterion-Reference Measure of Nursing Goal Attainment Tool – a measure defined as a process of of functional abilities and goal action, reaction, and attainment in the University of interaction whereby nurse Maryland Measurement of Nursing and client share information Outcomes project about their perceptions in Content Validity Index (CVI) – 0.88 the nursing situation Reliability – 0.99 Action – defined as a sequence of behaviors involving mental Metaparadigm of King and physical actions Person Reaction – not specified, but are spiritual beings might be considered as included have the ability through their in the sequence of behaviors language and other symbols described in action to record their history and Goal of Nurse – help individuals preserve their culture. maintain their health so they can are unique and holistic, of function in their roles intrinsic work capable of rational thinking and Domain of nurse – includes decision making in most promoting, maintaining, and situations restoring health, and caring for the is social being who is rational sick, injured, and dying and silent Function of professional nurse – to has the ability to perceive, interpret information in nursing think, feel, choose, set goals, process to plan, implement, and select means to have achieve evaluate nursing care goals, and to make decisions. Environment Health an understanding of the as dynamic life experiences ways that human beings of a human being, which interact with their implies continuous environment to maintain adjustment to stressors in health was essential for the internal and external nurses environment through  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO background for human appearance, which results from interactions others’ reactions to self. Internal environment – Learning – A process of nursing transforms energy to enable perception conceptualization and person to adjust to continuous critical thinking involving multiple external environmental changes experiences in which changes in concepts, skills, symbols, habits and External environment – involves values can be evaluated in formal and informal observable behaviors and inferred organizations. The nurse is a from behavioral manifestation. part of the patient’s environment Time – duration between the occurrence of one event and Theoretical Assertions occurrence of another event. King’s conceptual framework Personal Space – existing in all includes three interacting system directions and is same as being namely: everywhere. A. Personal Systems Coping – constantly changing Individual are personal systems. cognitive and behavioral efforts to Each individual is an open, total, manage specific internal and unique system in constant external demands. interaction with the environment. B. Interpersonal System Perception – process of organizing, Two or more individuals in interpreting, and transforming interaction form interpersonal information from sense data and systems. King’s process of nursing, memory of course, primarily within the Self – composite of thought and interpersonal systems between the feelings which constitute a person’s nurse and the patient. awareness of his/her existence Communication – Information Growth and development – processing, a change of information processes that take place in an from one state to another. individual’s life that help the Interaction – Acts of two or more individual move from potential persons in mutual presence. capacity for achievement to serve actualization. Role – Set of behaviors expected when occupying a position in a Body image – An individual’s social system. perception of his or her own body others, reaction to his or her Stress – Dynamic state whereby a human being interacts with the  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO environment to maintain balance relation to other groups in an for growth, development and organization. performance, which involve an Decision making – Dynamic and exchange of energy and systemic systematic process by information between the person which a goal directed choice of and the environment for regulation perceived alternatives is made, and and control of stressless. acted upon the individuals or Stressors – Events that produce groups to answer your question and stress. obtain a goal Transaction – Observable behaviors Application of Nursing Process of human beings interacting with Basic assumption of goal their environment. attainment theory is that nurse and C. Social System client communicate information set goal mutually and then act to attain Social systems are composed pf those goals. This is also the basic large groups with common assumption of nursing process. interests or goals. It is an organized boundary system of social role Assessment behaviors and practices developed King indicates that to maintain values in the assessment occur during mechanisms regulate the practice interaction. and rules. During assessment, nurse Examples are healthcare, settings, collects data regarding workplaces, educational client. institutions, religious organizations, Perception is the base for and families. collection and interpretation of data Organizations – a system was continuous activities are conducted Communication is required to achieve goals to verify accuracy of perception for interaction Authority – Transactional process and transaction. characterized by active reciprocal relations in defining validating and Diagnosis accepting the direction of According to king, in process individuals within an organization. of attaining gold, the nurse Power – The capacity or ability of a identifies the problems, group to achieve goals. concerns and servants as about which person seeks Status – The possession of an help. individual in a group or a group in  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Planning Implementation In goal attainment, planning In goal attainment, it is the is represented by setting continuation of transaction. goals and making decisions Evaluation about and being agreed on the means to achieve goals. In King’s description, This part of transaction in evolution speaks about client’s participation is attainment of goal and encouraged in making effectiveness of nursing decision on the means to care. achieve goals.  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Orem died on June 22, 2007 at age 92. Dorothea Major Concepts and Definition Orem 1914 - 2007 Nursing practice oriented by the SCDNT represents a caring approach that uses Nursing's concern "man's need for experiential and specialized self-care action and the provision and knowledge (Science) to management of it on a continuous design and produce nursing basis in order to sustain life and care (Art). health recover from disease or injury, The body of knowledge that and cope with their effects" guides the art and science incorporates empirical and Nursing's goal "overcoming human antecedent knowledge limitations" (Orem, 1995). History and Background Orem’s “Self-Care Deficit Nursing Theory (SCDNT) Dorothea Orem, one of America's foremost nursing The self-care deficit nursing theory theorists, was born in is a general theory composed of the Baltimore, Maryland in 1914. following four related theories: Dorothea Orem as a member I. The theory of self-care, which of a curriculum describes why and how people care subcommittee at Catholic for themselves. University recognized the need to continue developing II. The theory of dependent-care, a conceptualization of which explains how family members nursing. and/or friends provide dependent- care for a person who is socially Published first formal dependent. articulation of her ideas in "Nursing Concepts of III. The theory of self-care deficit, Practice" in 1971, second in which describes and explains why 1980 and finally in 1995. people can be helped through nursing. Dorothea Orem developed the Self-Care Deficit Nursing IV. The theory of nursing systems, Theory (SCDNT). which describes and explains relationships that must be brought about and maintained for nursing to be produced.  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO I. Theory of Self-Care 10. External environmental Self-Care comprises the practice of factors activities that maturing and mature persons initiate and perform, 4. Self-Care Requisites - actions within time frames, on their own directed towards provision of self- behalf in the interest of care. maintaining life, healthful functioning, continuing personal The three categories of self-care development, and well-being by requisites are: (a) universal, (b) meeting known requisites for developmental, and (c) health functional and developmental regulations. deviation. (a) Universal self-care requisites This theory includes: Associated with life processes and 1. Self-Care Practice of activities the maintenance of the integrity of that individuals initiate and perform human structure and functioning. independently on their behalf in Common to all, ADL (activities of maintaining life, health, and well- daily living) being. Eight self-care requisites common 2. Self-Care Agency - is conditioned to men, women, and children are by age, developmental state, life suggested: experience, sociocultural orientation, health, and available 1. Maintenance of sufficient intake resources. of air 2. Maintenance of a sufficient 3. Therapeutic Self-Care Demand intake of food "Totality of self-care actions to be 3. Maintenance of a sufficient performed for some duration in intake of water order to meet self-care requisites by 4. Provision of care associated using valid methods and related with elimination processes and sets of operations and actions". excrements Basic conditioning factors. Ten 5. Maintenance of balance factors have been identified: between activity and rest 6. Maintenance of balance 1. Age between solitude and social 2. Gender interaction 3. Developmental state 7. Prevention of hazards to human 4. Health state life, human functioning, and 5. Pattern of living human well- being 6. Health care system factors 8. Promotion of human 7. Family system factors functioning and development 8. Sociocultural factors within social groups in 9. Availability of resources accordance with human  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO potential, known human dependent-care provider's agency is limitations, and the human not adequate to meet the desire to be normal therapeutic self-care demand of the person receiving dependent-care (b) Developmental self-care requisites (DSCRs) Dependent-Care Demand is the summation of care measures at a Associated with developmental specific point in time or over a processes, derived from a duration of time for meeting the condition, or associated with an dependent's therapeutic, self-care event. demand when his or her self- care Three sets of DSCRs have been agency is not adequate or identified: operational. 1. Provision of conditions that III. Theory of Self-Care Deficit promote development Self-care deficit is the relationship 2. Engagement in self- between an individual's therapeutic development self-care demand and his or her 3. Prevention of or overcoming powers of self-care agency in which effects of human conditions the constituent-developed self-care and life situations that can adversely affect human capabilities within self-care agency development. are inoperable or inadequate for knowing and meeting some of all II. Theory of Dependent Care components of the existent or Dependent-care refers to the care projected therapeutic self-care that is provided to a person who, demand. because of age or related factors, is unable to perform the self-care Orem identified 5 methods of needed to maintain life, healthful helping: functioning continuing personal 1. Acting for and doing for development, and well-being others Dependent-care agency refers to 2. Guiding others the acquired ability of a person to 3. Supporting another know and meet the therapeutic self- 4. Providing an environment to care demand of the dependent promote a patient's ability. person and/or regulate the 5. Teaching another development and exercise of the IV. Theory of Nursing Systems dependent's self-care agency. Nursing systems are series and sequences of deliberate practical Dependent-care deficit is a actions of nurses performed at relationship that exists when the  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO times in coordination with the actions of their patients to know and meet components of patients’ therapeutic self-care demands and to protect and regulate the exercise of development of patients' self- care agency. Identifies 3 classifications of nursing systems to meet the self- care requisites of the patient: 1. Wholly compensatory system 2. Partially compensatory system 3. Supportive-educative system Wholly Compensatory System The patient is dependent, the nurse is expected to accomplish all the patient's therapeutic self- care or to compensate for the patient's inability to engage in SCDNT involves four structured self- care or when the patient cognitive operations as follows: needs continuous guidance in 1. Diagnostic self-care. 2. Prescriptive 3. Regulatory Partially Compensatory System 4. Control The patient can meet some Metaparadigm of Orem needs nursing assistance Both the nurse and the patient Person (Human Being, Nursing engage in meeting self-care Client) needs. A total being with universal, developmental needs and Supportive-educative System capable of continuous self-care. The patient can meet self-care A unity that can function requisites, but needs assistance biologically, symbolically and with decision making or socially. knowledge and skills to learn self-care.  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Has the capacity to reflect, and health- derived or symbolize, and use symbols. health-related conditions. A nursing client is a human Nursing therapeutics are being who has "health deliberate, systematic and related/health derived purposeful actions. limitations that render him Health incapable of continuous self- care or dependent care or When human beings are limitations that result in structurally and functionally ineffective/incomplete care. whole or sound. Wholeness or integrity Nursing includes that which makes a Is an art, a helping service, and a person human operating in technology conjunction with Actions deliberately selected physiological and and performed by nurses to help psychophysiological individuals or groups under their mechanisms and a material care to maintain or change structure and in relation to conditions in themselves or their and interacting with other environment human beings. Encompasses the patient's Environment perspective of health condition, the physician's perspective, and Components are the nursing perspective. environmental factors, environmental elements, The goal of nursing is to render the patient or members of his conditions, and developmental environment. family, capable of meeting the patient's self- care needs: a. To maintain a state of health. b. To regain normal or near normal state of health in the event of disease or injury. c. stabilize, control or minimize the effects of chronic poor health or disability. A nursing problem is deficit in universal, developmental,  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Bachelor of Science degree in Nursing, Master of Arts Faye Glenn degree in Physiology, and a Abdellah Doctor of Education degree. 1919 - 2017 Major Concepts and Definitions Patient Assessment of Care “Nursing is the use of problem- Evaluation (PACE) solving approach with key nursing a system of standards used problems related to the health needs to measure the relative of people” quality of individual health- History and Background care facilities that was still used in the health care was born on March 13, 1919, industry into the 21st century in New York City vowed to learn nursing after Diagnostic related groups (DRGs) the German hydrogen-fueled became the standard coding airship Hindenburg exploded system used by Medicare, over Lakehurst in New categorize patients Jersey according to particular helped change the primary and secondary profession’s focus from keeps healthcare costs down disease-centered approach 11 Nursing Skills by Abdellah to a patient-centered approach → Observation of Health Status served as a public nurse for → Skills of Communication 40 years in the U.S. Public → Application of Knowledge Health Service (PHS) → Teaching of patients and Commisioned Corps, helping families educate Americans about → Planning and organization of the needs of the elderly and work the dangers posed by AIDS, → Use of source materials addiction, smoking, and → Use of personal sources violence. → Problem-solving believed that nursing care → Direction of work of others should be based on research, → Therapeutic use of the self not hours of care → Nursing procedures earned three degrees from Columbia University:  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Twenty-one Nursing Problems SUSTENAL CARE NEEDS a model describing the 5. to facilitate maintenance of a “arenas” or concerns of supply of oxygen to all body nursing rather than a theory cells describing relationships 6. to facilitate maintenance of among phenomena nutrition of all body cells states that nursing is the use 7. to facilitate maintenance of of the problem solving elimination approach with key nursing 8. to facilitate maintenance of fluid problems related to the and electrolytes balance health needs of people 9. to recognize the physiological responses of the body to Three major categories disease conditions Physical, sociological, and 10. to facilitate maintenance of emotional needs of clients regulatory mechanisms and types of interpersonal functions relationships between the nurse 11. to facilitate maintenance of and patient sensory functions common elements of client care REMEDIAL CARE NEEDS Classification of the Twenty-one 12. to identify and accept positive Nursing Problems and negative expressions, BASIC TO ALL PATIENTS feelings, and reactions 1. to maintain good hygiene and 13. to identify and accept the physical comfort interrelatedness of emotions 2. to promote optimal activity: and organic illness exercise, rest, and sleep 14. to facilitate the maintenance of 3. to promote safety through the effective verbal and non-verbal prevention of accidents, injury communication or other trauma and through the 15. to promote the development of prevention of the spread of productive interpersonal infection relationships 4. to maintain good body 16. to facilitate progress toward mechanic and prevent and achievement of personal correct deformity spiritual goals 17. to create and/ or maintain a therapeutic environment 18. to facilitate awareness of self as an individual with varying  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO physical, emotional, and Problem Solving developmental needs Identifying the problem RESTORATION CARE NEEDS 19. to accept the optimum possible goals in the light of limitations, Selecting pertinent data physical and emotional 20. to use community resources as an aid in resolving problems Formulating hypothesis arising from illness 21. to understand the role of social problems as influencing factors Testing hypothesis in the case of illness Nursing Problems Nursing problem presented by a Revising hypothesis patient is a condition faced by the patient or patient's family Metaparadigm of Abdellah that the nurse through the Person performance of professional having physical, emotional, functions can assist them to and sociological needs meet. these needs may be over, The problem can be either can overt consisting of largely physical or covert nursing problem. needs or covert such as An overt nursing problem is an emotional and social needs apparent condition faced by the patient is described as the patient or family, which the only justification for the nurse can assist him or them to existence of nursing meet through the performance Nursing of her professional functions. Nursing is a helping profession. The covert nursing problem is It is doing something to or for concealed or hidden condition the person or providing faced, by the patient or family, information for the person with which the nurse can assist him the goals of meeting needs, or them to meet through the increasing or restoring self-help performance of her professional ability, or alleviating impairment functions.  NCM 100: Theoretical Foundations in Nursing USA CNND – BSN 1C ǀ GALIDO CASTRO Health a state mutually exclusive of illness Society and Environment society – planning for optimum health on local, national, and international levels environment – the home or community from which patient comes